Faculty Profiles - Obara Takafumi

Papers - Obara Takafumi

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Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion. International journal

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Masaki Hisamura, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 15 ( 1 ) 12633 - 12633 2025.4

Language：English Publishing type：Research paper (scientific journal)

Our study aims to explore how intensive care unit (ICU) occupancy by brain-dead organ donors affects emergency ambulance diversions. In this retrospective, single-center study at an emergency ICU (EICU), brain-dead organ donors were managed until organ procurement. We classified each day between August 1, 2021, and July 31, 2023, as either an exposure day (any day with a brain-dead organ donor in the EICU from admission to organ procurement) or a control day (all other days). The study compared these days and used multiple logistic regression analysis to assess the impact of EICU occupancy by brain-dead organ donors on ambulance diversions. Over two years, 6,058 emergency patients were transported by ambulance, with 1327 admitted to the EICU, including 13 brain-dead organ donors. Brain-dead donors had longer EICU stays (17 vs. 2 days, P < 0.001). With 168 exposure and 562 control days, EICU occupancy was higher on exposure days (75% vs. 67%, P = 0.003), leading to more ambulance diversions. Logistic regression showed exposure days significantly increased ambulance diversions, with an odds ratio of 1.79 (95% CIs 1.10-2.88). This study shows that managing brain-dead organ donors in the EICU leads to longer stays and higher occupancy, resulting in more frequent ambulance diversions. These findings highlight the critical need for policies that optimize ICU resource allocation while maintaining the infrastructure necessary to support organ donation programs and ensuring continued care for brain-dead donors, who play an essential role in addressing the organ shortage crisis.

DOI： 10.1038/s41598-025-97198-7

Age-specific assessment of initial hemoglobin levels and shock index for predicting life-saving interventions in pediatric blunt liver and spleen injuries. Reviewed International journal

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Atsuyoshi Iida, Kohei Tsukahara, Morihiro Katsura, Yutaka Kondo, Hideto Yasuda, Shigeki Kushimoto, Takashi Yorifuji, Hiromichi Naito, Atsunori Nakao

Scientific reports 15 ( 1 ) 8502 - 8502 2025.3

Language：English Publishing type：Research paper (scientific journal)

This study aimed to evaluate the effectiveness of combining initial hemoglobin levels with the shock index for predicting the need for life-saving interventions (LSI) in pediatric patients with blunt liver and spleen injuries (BLSI), specifically tailored to different age groups. This was a multicenter retrospective cohort study of pediatric patients with BLSI in Japan. The area under the receiver operating characteristic curve (AUROC) were used to assess predictive accuracy. The study included 1,370 patients. LSI was required in 59 of 247 (23.9%) aged 1 to 6 years, 100 of 402 (24.9%) aged 7 to 12 years, and 125 of 297 (42.1%) patients aged 13 to 16 years. Within each specific age group, the predictability was categorized as fair and appeared higher than that of the entire cohort or when using either parameter alone. Notably, in the 1 to 6-year age group, the combined values showed the highest predictability, which was statistically superior to the shock index alone (AUROC of 0.770 vs. 0.671, P = 0.025). Tailoring initial hemoglobin levels and shock index to specific age groups enhances predictability of LSI in pediatric BLSI, showing a fair level of predictive accuracy.

DOI： 10.1038/s41598-025-92673-7

Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study. International journal

Takashi Hongo, Tetsuya Yumoto, Shunta Jinno, Yuka Yamamura, Takafumi Obara, Tsuyoshi Nojima, Kohei Tsukahara, Hiromichi Naito, Takashi Yorifuji, Atsunori Nakao

Resuscitation plus 22 100923 - 100923 2025.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Suicide-related out-of-hospital cardiac arrest (OHCA) is characterized by extremely low survival rates and represents a considerable global public health concern. This study aimed to investigate the prevalence, characteristics, and outcomes of suicide-related OHCA. METHODS: This multicenter, retrospective cohort study is an analysis of data collected from the JAPAN Registry of Self-harm and Suicide Attempts. Patients were divided into two groups, the OHCA group and the non-OHCA group. The primary outcome was death at 30 days. RESULTS: Among 1,960 self-harm and suicide attempts patients, 213 patients (10.9 %) were assigned to the OHCA group and 1,747 (89.1%) were in the non-OHCA group.Patients in the OHCA group were older (44 vs. 33 years old, p < 0.001), and the OHCA group had a higher proportion of males compared to the non-OHCA group (122 [57.3%] vs. 604 [34.6%], p < 0.001). Despite missing and unknown data, lower proportions of psychiatric consultation history (54 [30.8%] vs. 1177 [70.5%], p < 0.001), psychiatric hospitalization history (9 [5.1%] vs. 386 [23.1%], p < 0.001), and previous suicide attempts (16 [9.2%] vs. 807 [48.4%], p < 0.001) were observed in the OHCA group. Risk of death at 30 days was significantly higher in the OHCA group (200 [93.9%] vs. 31 [1.8%], p < 0.001). CONCLUSION: Suicide-related OHCA was rare and associated with poorer prognosis compared to patients without OHCA. It was more common in middle-aged men without a history of psychiatric care or prior suicide attempts, although the study was limited by missing data.

DOI： 10.1016/j.resplu.2025.100923

Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out‐of‐hospital cardiac arrest Reviewed

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Tomohiro Hiraoka, Yuya Murakami, Takafumi Obara, Tsuyoshi Nojima, Toshiyuki Aokage, Atsunori Nakao

Acute Medicine & Surgery 2025.1

Differences in the Usability of Fully Automated External Defibrillators between Medical and Nonmedical Professionals. Reviewed

Tsuyoshi Nojima, Takafumi Obara, Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Internal medicine (Tokyo, Japan) 2024.12

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

DOI： 10.2169/internalmedicine.4578-24

救急搬送件数の急増と働き方改革への対応岡山大学の取り組み

湯本哲也, 内藤宏道, 本郷貴識, 小原隆史, 小崎吉訓, 上田浩平, 野島剛, 飯田淳義, 塚原紘平, 中尾篤典

日本臨床救急医学会雑誌 27 ( 6 ) 765 - 771 2024.12

Language：Japanese Publisher：(一社)日本臨床救急医学会

2024年4月から医師にも働き方改革が適用された。当院では救急搬送件数が直近3年間で3倍に急増した。これに対応するため院内外の協力・連携や下り搬送の体制強化,病院救命士の活用・育成によるタスク・シェア/シフトの促進に努めてきた。その他,徹底したシフト制など働き方改革を進めてきた。また,大学病院としての使命でもある研究・教育にも注力してきた。2023年度の院内時間外勤務時間は2022年度のそれと比較して有意に減少したものの,働き方改革前後での全体的な満足度に変化はなかった。働き方改革は労働時間もさることながら,その中身が重要であり,救急科としての専門性や役割を発揮しながら,個々がやりがいを実感できる環境づくりが重要であるが,自己研鑽という名の時間外労働の実態は反映されにくく,地域救急医療体制維持と働き方改革とのバランスも今後の課題である。(著者抄録)

脳死下臓器提供のプロセスに関する包括的研究多機関共同後ろ向き研究J-RESPECT studyより

湯本哲也, 内藤宏道, 塚原紘平, 小原隆史, 本郷貴識, 早川峰司, 横堀將司, 西山慶, 渥美生弘, 田崎修, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 666 - 666 2024.11

COVID-19流行前後における小児院外心停止例に対するBystander CPRの変化とアウトカムの検証

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

蘇生 43 ( 3 ) 188 - 188 2024.11

脳疾患による院外心停止の特徴に関して

内藤宏道, 野島剛, 本郷貴識, 小原隆史, 湯本哲也, 中尾篤典

蘇生 43 ( 3 ) 182 - 182 2024.11

院外心停止患者における来院時体温による体温管理療法と30日後の神経学的予後

野島剛, 内藤宏道, 小原隆史, 田邉綾, 本郷貴識, 小崎吉訓, 上田浩平, 湯本哲也, 塚原紘平, 中尾篤典

蘇生 43 ( 3 ) 181 - 181 2024.11

低体温症における来院時血中COHbの意義についての検証

三次悠哉, 湯本哲也, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 812 - 812 2024.11

ヘリウムガス吸入による心停止蘇生後に脳死下臓器提供に至った一例

神野駿太, 湯本哲也, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 782 - 782 2024.11

心停止のエピソードがあった症例の脳死下および心停止下臓器提供 ECPRの有無による比較

湯本哲也, 塚原紘平, 小原隆史, 本郷貴識, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 781 - 781 2024.11

心肺蘇生を望まない意思表示のある院外心停止患者対応の実態と今後の展望

田邉綾, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 稲葉基高, 小崎吉訓, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 752 - 752 2024.11

オール岡山での搬送困難事例を減らすための取り組み高齢者施設における急変時等相談対応事業を開始して

湯本哲也, 田邉綾, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 688 - 688 2024.11

敗血症患者における来院時血中COHbの意義についての検証

福留将真, 湯本哲也, 薬師寺泰匡, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 645 - 645 2024.11

いざ、多臓器不全に立ち向かえ!最新の基礎研究を眺めてみよう治療的医療ガスのクリティカルケア領域への応用

湯本哲也, 青景聡之, 小原隆史, 上田浩平, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 613 - 613 2024.11

A nationwide longitudinal survey of infantile injury and its recurrence in Japan. Reviewed International journal

Tomohiro Hiraoka, Takafumi Obara, Naomi Matsumoto, Kohei Tsukahara, Takashi Hongo, Tsuyoshi Nojima, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 14 ( 1 ) 24716 - 24716 2024.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

DOI： 10.1038/s41598-024-76403-z

Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. Reviewed International journal

Takafumi Obara, Tetsuya Yumoto, Naofumi Bunya, Tsuyoshi Nojima, Tomohiro Hiraoka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Takenori Uehara, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100701 - 100701 2024.9

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. METHODS: Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. RESULTS: A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. CONCLUSIONS: TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.

DOI： 10.1016/j.resplu.2024.100701

臓器提供支援事業の現状と課題岡山県の臓器提供施設連携体制構築事業

内藤宏道, 塚原紘平, 湯本哲也, 本郷貴織, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 飯田淳義, 久村正樹, 安田和広, 中尾篤典

移植 59 ( 総会臨時 ) 231 - 231 2024.9

私(僕)の臨床研究、興味ありませんか? 救急集中治療の現場で臨床医が取り組む「小児」のデータベース研究の可能性

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S485 - S485 2024.9

Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. Reviewed International journal

Tetsuya Yumoto, Takashi Hongo, Takafumi Obara, Kohei Ageta, Toshiyuki Aokage, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Journal of clinical medicine 13 ( 15 ) 2024.7

Language：English Publishing type：Research paper (scientific journal)

Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.

DOI： 10.3390/jcm13154324

後頭部可逆性白質脳症を合併した肢端紅痛症の1例

武川真也, 鈴木健吾, 宇田和宏, 茂原研司, 荒川恭佑, 齋藤有希惠, 宮原宏幸, 長谷川高誠, 小原隆史, 塚原紘平, 八代将登, 津下充, 塚原宏一

日本小児科学会雑誌 128 ( 7 ) 1004 - 1005 2024.7

後頭部可逆性白質脳症を合併した肢端紅痛症の1例

武川真也, 鈴木健吾, 宇田和宏, 茂原研司, 荒川恭佑, 齋藤有希惠, 宮原宏幸, 長谷川高誠, 小原隆史, 塚原紘平, 八代将登, 津下充, 塚原宏一

日本小児科学会雑誌 128 ( 7 ) 1004 - 1005 2024.7

Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study. Reviewed International journal

Shunsuke Nakamura, Tsuyoshi Nojima, Takafumi Obara, Takashi Hongo, Tetsuya Yumoto, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 18 100659 - 100659 2024.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings. METHODS: We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders' sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes. RESULTS: The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76-1.61), 30-day survival (aOR 1.23, 95% CI: 0.83-1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34-1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest. CONCLUSION: There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.

DOI： 10.1016/j.resplu.2024.100659

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study. Reviewed International journal

Tetsuya Yumoto, Kohei Tsukahara, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

Critical care (London, England) 28 ( 1 ) 160 - 160 2024.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. METHODS: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. RESULTS: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. CONCLUSIONS: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.

DOI： 10.1186/s13054-024-04949-5

Changes in temporal muscle dimensions and their clinical impact in out-of-hospital cardiac arrest survivors Reviewed

Takashi Hongo, Hiromichi Naito, Keibun Liu, Yuya Murakami, Satoshi Nozaki, Hiroki Maeyama, Ayaka Matsuoka, Hisashi Dote, Kazumasa Inaba, Satoshi Miike, Shigeki Fujitani, Tomohiro Hiraoka, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Tetsuya Yumoto

Resuscitation Plus 17 100527 - 100527 2024.3

法的脳死判定時にCPAPモードを用いた無呼吸テストを実施した小児2例

平岡知浩, 小原隆史, 塚原紘平, 難波宏太, 岡田真澄, 平山隆浩, 湯本哲也, 内藤宏道, 中尾篤典

日本小児科学会雑誌 128 ( 2 ) 361 - 361 2024.2

Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor. Reviewed

Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Tomohiro Hiraoka, Kohei Tsukahara, Tsuyoshi Nojima, Takafumi Obara, Kohei Ageta, Yukie Yamasaki, Kaori Taniguchi, Masanobu Miura, Satoru Miyaishi, Hiromichi Naito, Atsunori Nakao

JMA journal 7 ( 1 ) 133 - 135 2024.1

Language：English

Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.

DOI： 10.31662/jmaj.2023-0081

Hydrogen in Transplantation: Potential Applications and Therapeutic Implications. Reviewed International journal

Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Takahiro Hirayama, Takashi Hongo, Kohei Ageta, Toshiyuki Aokage, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao

Biomedicines 12 ( 1 ) 2024.1

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

Hydrogen gas, renowned for its antioxidant properties, has emerged as a novel therapeutic agent with applications across various medical domains, positioning it as a potential adjunct therapy in transplantation. Beyond its antioxidative properties, hydrogen also exerts anti-inflammatory effects by modulating pro-inflammatory cytokines and signaling pathways. Furthermore, hydrogen's capacity to activate cytoprotective pathways bolsters cellular resilience against stressors. In recent decades, significant advancements have been made in the critical medical procedure of transplantation. However, persistent challenges such as ischemia-reperfusion injury (IRI) and graft rejection continue to hinder transplant success rates. This comprehensive review explores the potential applications and therapeutic implications of hydrogen in transplantation, shedding light on its role in mitigating IRI, improving graft survival, and modulating immune responses. Through a meticulous analysis encompassing both preclinical and clinical studies, we aim to provide valuable insights into the promising utility of hydrogen as a complementary therapy in transplantation.

DOI： 10.3390/biomedicines12010118

Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. Reviewed International journal

Ryo Tanabe, Takashi Hongo, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito, Tetsuya Yumoto

Resuscitation plus 16 100507 - 100507 2023.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. METHODS: A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. RESULTS: Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. CONCLUSIONS: The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.

DOI： 10.1016/j.resplu.2023.100507

EICUでのドナー管理と救急応需率との関係

湯本哲也, 本郷貴識, 小崎吉訓, 小原隆史, 上田浩平, 野島剛, 飯田淳義, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 855 - 855 2023.12

バルプロ酸徐放剤とオランザピン過量内服により遅発性に高アンモニア血症を生じた1例

萩原万瀧, 野島剛, 本郷貴識, 小原隆史, 小崎吉訓, 湯本哲也, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 798 - 798 2023.12

アセトアミノフェン中毒に対する一酸化炭素放出物質(CORM-401)の新規治療法としての可能性

青景聡之, Meng Ying, 小原隆史, 湯本哲也, 平山隆浩, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 717 - 717 2023.12

Evaluation for Blood Concentration and Efficacy/Safety of Continuous Administration of Thiamylal in Children. Reviewed International journal

Kenshiro Hirata, Takafumi Obara, Tokunori Ikeda, Hiroshi Watanabe, Issei Fujita, Hirokazu Furusho, Takako Ishiguro, Sachiko Jingami, Toru Maruyama, Katsuki Hirai, Shigeyuki Miyamura

Therapeutic drug monitoring 46 ( 3 ) 397 - 403 2023.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Thiamylal exerts excellent sedative effects. However, it is not routinely used because of its serious adverse effects. This study aimed to clarify the target blood concentration range and infusion rate of thiamylal in children by measuring its blood concentration and evaluating its relationship with efficacy and adverse effects. METHODS: This study was approved by the Ethics Committee of Japanese Red Cross Kumamoto Hospital. The authors included 10 children aged between 1 and 7 years who had received continuous intravenous (IV) infusion of thiamylal for the management of refractory status epilepticus, excluding those who met the exclusion criteria. After a 2 mg/kg bolus injection of thiamylal, continuous IV infusion was initiated at a rate of 2-3 mg/kg/h. Thiamylal concentration in the blood was measured using high-performance liquid chromatography. The State Behavioral Scale and the frequency of bolus injections were used to evaluate efficacy. Blood pressure and heart rate were measured to evaluate adverse effects. Statistical analyses of the time to awakening and the factors affecting it were also conducted. RESULTS: The State Behavioral Scale score during thiamylal administration was -2 or lower in all cases, suggesting that the depth of sedation was sufficient. The frequency of bolus injections decreased in a blood concentration-dependent manner, suggesting that the frequency tended to decrease, especially at thiamylal blood concentrations of 20 mcg/mL or higher. An increase of the infusion rate to 3 mg/kg/h was recommended, because the blood concentration may not reach 20 mcg/mL at an infusion rate of 2 mg/kg/h. There was also a case in which a rapid increase in blood concentration accompanied by a decrease in blood pressure and heart rate was observed when the infusion rate was increased to 4 mg/kg/h. Furthermore, the time to awakening after the end of administration correlated with the highest blood concentration during administration; therefore, delayed awakening was noted when using a high dose of thiamylal. CONCLUSIONS: The target blood concentration of thiamylal in children should be 20-30 mcg/mL, and the infusion rate should be based on 3 mg/kg/h.

DOI： 10.1097/FTD.0000000000001153

Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor. Reviewed International journal

Tetsuya Yumoto, Takashi Hongo, Yasuhiro Koide, Takafumi Obara, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

BMC medical ethics 24 ( 1 ) 80 - 80 2023.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. CASE PRESENTATION: A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. CONCLUSIONS: Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.

DOI： 10.1186/s12910-023-00962-5

Schmorl's Node Found with Acute Lower Back Pain. Reviewed

Kenji Aoshima, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao

Internal medicine (Tokyo, Japan) 2023.7

アセトアミノフェン中毒におけるプロカルシトニンの有用性

野島剛, 本郷貴識, 小原隆史, 小崎吉訓, 飯田淳義, 湯本哲也, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

中毒研究 36 ( 2 ) 207 - 207 2023.7

救急医療現場における個人的信念に基づく医療行為拒否への対応放射線被曝拒否事例から考える

小出恭大, 湯本哲也, 本郷貴識, 小崎吉訓, 野島剛, 上田浩平, 小原隆史, 飯田淳義, 山本浩継, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 26 ( 3 ) 358 - 358 2023.7

体温管理療法中の温度管理が筋萎縮にあたえる影響の検討

本郷貴識, 小原隆史, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 48 - 48 2023.6

当科における小児急性脳症と体温管理療法の現状

小原隆史, 塚原紘平, 平岡知浩, 本郷貴識, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 47 - 47 2023.6

Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice. Reviewed International journal

Kohei Ageta, Takahiro Hirayama, Toshiyuki Aokage, Mizuki Seya, Ying Meng, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takafumi Obara, Atsunori Nakao, Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito

Surgery 2023.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Lung contusion caused by blunt chest trauma evokes a severe inflammatory reaction in the pulmonary parenchyma that may be associated with acute respiratory distress syndrome. Although hydrogen gas has antioxidant and anti-inflammatory effects and is protective against multiple types of lung injury at safe concentrations, the effects of inhaled hydrogen gas on blunt lung injury have not been previously investigated. Therefore, using a mouse model, we tested the hypothesis that hydrogen inhalation after chest trauma would reduce pulmonary inflammation and acute lung injury associated with lung contusion. METHODS: Inbred male C57BL/6 mice were randomly divided into 3 groups: sham with air inhalation, lung contusion with air inhalation, and lung contusion with 1.3% hydrogen inhalation. Experimental lung contusion was induced using a highly reproducible and standardized apparatus. Immediately after induction of lung contusion, mice were placed in a chamber exposed to 1.3% hydrogen gas in the air. Histopathological analysis and real-time polymerase chain reaction in lung tissue and blood gas analysis were performed 6 hours after contusion. RESULTS: Histopathological examination of the lung tissue after contusion revealed perivascular/intra-alveolar hemorrhage, perivascular/interstitial leukocyte infiltration, and interstitial/intra-alveolar edema. These histological changes and the extent of lung contusion, as determined by computed tomography, were significantly mitigated by hydrogen inhalation. Hydrogen inhalation also significantly reduced inflammatory cytokine and chemokine mRNA levels and improved oxygenation. CONCLUSION: Hydrogen inhalation therapy significantly mitigated inflammatory responses associated with lung contusion in mice. Hydrogen inhalation therapy may be a supplemental therapeutic strategy for treating lung contusion.

DOI： 10.1016/j.surg.2023.04.029

Hydrogen gas treatment improves survival in a rat model of crush syndrome by ameliorating rhabdomyolysis Reviewed

Tetsuya Yumoto, Toshiyuki Aokage, Takahiro Hirayama, Hirotsugu Yamamoto, Takafumi Obara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

European Journal of Inflammation 21 1721727X2311685 - 1721727X2311685 2023.3

Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

Objectives

Crush syndrome (CS) is characterized by a systemic manifestation of traumatic rhabdomyolysis, leading to multiple organ dysfunction and death. Ischemia-reperfusion (IR) injury is commonly responsible for systemic response. Extending studies have shown that hydrogen gas treatment ameliorated IR injury in numerous experimental models; however, its effect on CS has not been well examined. This study aimed to investigate the effects of hydrogen gas inhalation following crush injury in an experimental model of CS.

Methods

Male Sprague-Dawley rats were subjected to experimental CS by applying a total of 3.0 kg weight to both hindlimb under general anesthesia for 6 h. Immediately after decompression, the animals were randomly placed in a gas chamber filled with either air or 1.3% hydrogen gas. Animals were sacrificed 18 h or 24 h following gas exposure for non-survival studies or for survival study, respectively.

Results

The rats with hydrogen treatment ( n = 6) had a higher 24-h survival than the rats with air treatment ( n = 9) (100% vs. 44%, p = 0.035). Lactate concentrations (2.9 ± 0.2 vs. 2.2 ± 0.2 mmol/L, p = 0.040) and creatine kinase (34,178 ± 13,580 vs. 5005 ± 842 IU/L, p = 0.016) were lower in the hydrogen group compared with the air group 18 h after decompression ( n = 4 in the air group, and n = 5 in the H₂ group). Histological analysis revealed that the damage to the rectus femoris muscle and kidney appeared to be ameliorated by hydrogen treatment.

Conclusion

Hydrogen gas inhalation may be a promising therapeutic approach in the treatment of CS.

DOI： 10.1177/1721727x231168547

Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/1721727X231168547

Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. Reviewed International journal

Takafumi Obara, Tetsuya Yumoto, Tsuyoshi Nojima, Takashi Hongo, Kohei Tsukahara, Naomi Matsumoto, Takashi Yorifuji, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2023.2

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective cohort study. SETTING: Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS: None. PATIENTS: Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS: We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS: Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.

DOI： 10.1097/PCC.0000000000003206

Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death. Reviewed

Takafumi Obara, Tetsuya Yumoto, Kenji Aoshima, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Acta medica Okayama 77 ( 1 ) 117 - 120 2023.2

Authorship：Lead author Language：English

A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.

DOI： 10.18926/AMO/64372

Successfully treated case of severe hypothermia secondary to myxedema coma. Reviewed International journal

Hirotsugu Yamamoto, Takashi Hongo, Tsuyoshi Nojima, Takafumi Obara, Yoshinori Kosaki, Kohei Ageta, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

Acute medicine & surgery 10 ( 1 ) e828 2023

Language：English

BACKGROUND: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. CASE PRESENTATION: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. CONCLUSION: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

DOI： 10.1002/ams2.828

Transcranial doppler ultrasound in a 3-month-old infant with brain death. Reviewed International journal

Tomohiro Hiraoka, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao

Pediatrics international : official journal of the Japan Pediatric Society 65 ( 1 ) e15587 2023

Early-stage antibody kinetics after the third dose of BNT162b2 mRNA COVID-19 vaccination measured by a point-of-care fingertip whole blood testing Reviewed

Hideharu Hagiya, Yasuhiro Nakano, Masanori Furukawa, Naruhiko Sunada, Toru Hasegawa, Yasue Sakurada, Kou Hasegawa, Koichiro Yamamoto, Hiroko Ogawa, Takafumi Obara, Kouhei Ageta, Naomi Matsumoto, Rumi Matsuo, Tomoka Kadowaki, Akihito Higashikage, Takao Hikita, Takashi Yorifuji, Shinichi Toyooka, Yoshinobu Maeda, Yoshinori Yokokura, Fumio Otsuka, Masanori Nakayama

Scientific Reports 12 ( 1 ) 2022.11

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Amid the Coronavirus Disease 2019 pandemic, we aimed to demonstrate the accuracy of the fingertip whole blood sampling test (FWT) in measuring the antibody titer and uncovering its dynamics shortly after booster vaccination. Mokobio SARS-CoV-2 IgM & IgG Quantum Dot immunoassay (Mokobio Biotechnology R&D Center Inc., MD, USA) was used as a point-of-care FWT in 226 health care workers (HCWs) who had received two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) at least 8 months prior. Each participant tested their antibody titers before and after the third-dose booster up to 14-days. The effect of the booster was observed as early as the fourth day after vaccination, which exceeded the detection limit (> 30,000 U/mL) by 2.3% on the fifth day, 12.2% on the sixth day, and 22.5% after the seventh day. Significant positive correlations were observed between the pre- and post-vaccination (the seventh and eighth days) antibody titers (correlation coefficient, 0.405; p < 0.001). FWT is useful for examining antibody titers as a point-of-care test. Rapid response of antibody titer started as early as the fourth day post-vaccination, while the presence of weak responders to BNT162b2 vaccine was indicated.

DOI： 10.1038/s41598-022-24464-3

Other Link： https://www.nature.com/articles/s41598-022-24464-3

臓器移植におけるドナー管理(臓器保護の観点から) 6歳未満おける臓器移植ドナー管理の特徴

小原隆史, 内藤宏道, 塚原紘平, 青景聡之, 野島剛, 上田浩平, 小崎吉訓, 山田太平, 藤崎宣友, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 297 - 297 2022.11

臓器移植におけるドナー管理(臓器保護の観点から) 6歳未満おける臓器移植ドナー管理の特徴

小原隆史, 内藤宏道, 塚原紘平, 青景聡之, 野島剛, 上田浩平, 小崎吉訓, 山田太平, 藤崎宣友, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 297 - 297 2022.11

治療的医学ガス(Medical gas)を救急集中治療領域へ応用する救急医による挑戦

小原隆史, 青景聡之, 山本浩継, 野島剛, 上田浩平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 823 - 823 2022.10

デジタル田園健康特区における救急救命士の権限・役割の拡大による救急体制の充実への取り組み

上田浩平, 本郷貴識, 小原隆史, 野島剛, 湯本哲也, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 872 - 872 2022.10

産科情報共有システム「iPicss」により迅速な対応ができた出産中の脳出血の搬送例

佐々並三紗, 小崎吉訓, 塚原紘平, 牧尉太, 中尾篤典, 内藤宏道, 湯本哲也, 上田浩平, 小原隆史, 本郷貴識, 平岡知浩

日本救急医学会雑誌 33 ( 10 ) 806 - 806 2022.10

Luminal administration of biliverdin ameliorates ischemia-reperfusion injury following intestinal transplant in rats. Reviewed International journal

Tsuyoshi Nojima, Takafumi Obara, Hirotsugu Yamamoto, Tetsuya Yumoto, Takuro Igawa, Toshiyuki Aokage, Mizuki Seya, Atsunori Nakao, Hiromichi Naito

Surgery 172 ( 5 ) 1522 - 1528 2022.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Intestinal grafts are susceptible to ischemia-reperfusion injury, resulting in the loss of mucosal barrier function and graft failure. Biliverdin is known to exert a variety of cytoprotective functions against oxidative tissue injury. Because the mucosal layer is the primary site of ischemia-reperfusion injury, mucosa-targeting strategies by luminal delivery of reagents might be beneficial. We tested whether intraluminal administration of biliverdin as an adjuvant to standard preservation solutions protected against ischemia-reperfusion injury. METHODS: Orthotopic syngeneic intestinal transplants were performed on Lewis rats after 6 hours of cold preservation. Saline containing biliverdin (10 μM) or without biliverdin was introduced into the lumen of the intestinal grafts immediately before cold preservation. RESULTS: Damage to the intestinal mucosa caused by ischemia-reperfusion injury resulted in severe morphological changes, including blunting of the villi and erosion, and led to significant loss of gut barrier function 3 hours after reperfusion. These changes to the mucosa were notably ameliorated by intraluminal administration of biliverdin. Biliverdin also effectively inhibited upregulation of messenger RNAs for interleukin-6, inducible nitric oxide synthase, and C-C motif chemokine 2. Additionally, biliverdin treatment prevented the loss of expression of claudin-1, a transmembrane, tight-junction barrier protein. The 14-day survival of recipients of biliverdin-treated grafts was significantly improved as compared with the recipients of saline-treated control grafts (83.3% vs 38.9%, P = .030). CONCLUSION: This study demonstrated that luminally delivered biliverdin provides beneficial effects during the transplant of rat small intestinal grafts and could be an attractive therapeutic option in organ transplantation.

DOI： 10.1016/j.surg.2022.07.021

Luminal Administration of a Water-soluble Carbon Monoxide-releasing Molecule (CORM-3) Mitigates Ischemia/Reperfusion Injury in Rats Following Intestinal Transplantation. Reviewed International journal

Takafumi Obara, Hirotsugu Yamamoto, Toshiyuki Aokage, Takuro Igawa, Tsuyoshi Nojima, Takahiro Hirayama, Mizuki Seya, Michiko Ishikawa-Aoyama, Atsunori Nakao, Roberto Motterlini, Hiromichi Naito

Transplantation 106 ( 7 ) 1365 - 1375 2022.7

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The protective effects of carbon monoxide (CO) against ischemia/reperfusion (IR) injury during organ transplantation have been extensively investigated. Likewise, CO-releasing molecules (CORMs) are known to exert a variety of pharmacological activities via liberation of controlled amounts of CO in organs. Therefore, we hypothesized that intraluminal administration of water-soluble CORM-3 during cold storage of intestinal grafts would provide protective effects against IR injury. METHODS: Orthotopic syngeneic intestinal transplantation was performed in Lewis rats following 6 h of cold preservation in Ringer solution or University of Wisconsin solution. Saline containing CORM-3 (100 µmol/L) or its inactive counterpart (iCORM-3) was intraluminally introduced in the intestinal graft before cold preservation. RESULTS: Histopathological analysis of untreated and iCORM-3-treated grafts revealed a similar erosion and blunting of the intestinal villi. These changes in the mucosa structure were significantly attenuated by intraluminal administration of CORM-3. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h postreperfusion. CORM-3 significantly inhibited upregulation of proinflammatory mRNA levels, ameliorated intestinal morphological changes, and improved graft blood flow and mucosal barrier function. Additionally, CORM-3-treated grafts increased recipient survival rates. Pharmacological blockade of soluble guanylyl cyclase activity significantly reversed the protective effects conferred by CORM-3, indicating that CO partially mediates its therapeutic actions via soluble guanylyl cyclase activation. CONCLUSIONS: Our study demonstrates that luminally delivered CORM-3 provides beneficial effects in cold-stored rat small intestinal grafts and could be an attractive therapeutic application of CO in the clinical setting of organ preservation and transplantation.

DOI： 10.1097/TP.0000000000004007

キノコ中毒におけるプロカルシトニンによる診断は有用か

野島剛, 湯本哲也, 小崎吉訓, 小原隆史, 上田浩平, 塚原紘平, 山田太平, 内藤宏道, 中尾篤典

中毒研究 35 ( 2 ) 153 - 153 2022.7

Adult Scurvy Presenting with Painful Purpura on the Legs.

Nayu Tamura, Takafumi Obara, Taihei Yamada, Tsuyoshi Nojima, Shunsuke Nakamura, Yasuhiro Koide, Makoto Takaoka, Hiromichi Naito, Atsunori Nakao

Internal medicine (Tokyo, Japan) 61 ( 12 ) 1913 - 1916 2022.6

Language：English Publishing type：Research paper (scientific journal)

Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.

DOI： 10.2169/internalmedicine.8409-21

Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study. Reviewed International journal

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Ageta, Hiromasa Yakushiji, Tetsuya Yumoto, Noritomo Fujisaki, Atsunori Nakao

Journal of clinical medicine 11 ( 9 ) 2022.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient's condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. RESULTS: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival. CONCLUSIONS: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

DOI： 10.3390/jcm11092566

脳卒中様症状を呈した急性大動脈解離の1例

加藤篤之, 野島剛, 小原隆史, 塚原紘平, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 25 ( 2 ) 329 - 329 2022.5

日本外傷学会データバンクを用いた熱傷症例の検討

野島剛, 内藤宏道, 小原隆史, 小崎吉訓, 上田浩平, 塚原紘平, 中尾篤典

熱傷 48 ( 1 ) 38 - 39 2022.3

当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

小原隆史, 塚原紘平, 野島剛, 上田浩平, 山本浩継, 内藤宏道, 中尾篤典

熱傷 48 ( 1 ) 41 - 41 2022.3

Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan. Reviewed International journal

Takafumi Obara, Hiromichi Naito, Kohei Tsukahara, Naomi Matsumoto, Hirotsugu Yamamoto, Takashi Yorifuji, Atsunori Nakao

International journal of environmental research and public health 18 ( 18 ) 2021.9

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5-nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19-1.66, 7 h: aOR 1.10, 95% CI, 0.98-1.23, 8 h: aOR 1.13, 95% CI, 1.02-1.26, irregular: aOR 1.26, 95% CI 1.10-1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

DOI： 10.3390/ijerph18189512

Carbon monoxide poisoning during pregnancy treated with hyperbaric oxygen. Reviewed International journal

Yoshinori Kosaki, Hiroki Maeyama, Tsuyoshi Nojima, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

Clinical case reports 9 ( 5 ) e04138 2021.5

マムシ抗毒素投与が奏功した血小板減少型マムシ咬傷の1例

岡本彩, 向笠廣太, 小原隆史, 野島剛, 中尾篤典, 鬼塚拡平, 浦部尚吾, 井上智博, 古賀仁士, 山下寿

佐賀救急医学会雑誌 7 ( 1 ) 11 - 14 2021.3

Language：Japanese Publisher：佐賀救急医学会

74歳男性。農作業中に右示指をマムシに咬まれ意識消失し、受傷30分後に当院へ搬送となった。所見では意識清明で、右示指に滲出性出血を伴う創があった。出血持続、全身紫斑、血小板減少を認めたことから、マムシ毒による血小板減少と診断され、受傷5時間後にマムシ抗毒素を投与した。その結果、血小板数や症状は速やかに改善し、第15病日に退院となった。

Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. Reviewed International journal

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao

Archives of academic emergency medicine 9 ( 1 ) e16 2021

Language：English

Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.

Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands. Reviewed International journal

Tsuyoshi Nojima, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Case reports in emergency medicine 2021 9940395 - 9940395 2021

Language：English

INTRODUCTION: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Case Report. An 18-year-old man with severe head trauma was admitted to our hospital. Initial computed tomography (CT) revealed a high attenuation of intraocular silicone that could be mistaken for a hemorrhage. Ophthalmological examination and detailed ophthalmic history confirmed silicone oil in his eye for treatment of retinal detachment. Knowledge of the anatomical changes and radiological appearance of postsurgical findings following retinal detachment, including the surgical materials of silicone oil or bands, can prevent unnecessary alarm. CONCLUSION: Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.

DOI： 10.1155/2021/9940395

Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single-center study. Reviewed International journal

Kyoichi Obata, Hiromichi Naito, Hiromasa Yakushiji, Takafumi Obara, Kisho Ono, Tsuyoshi Nojima, Kohei Tsukahara, Taihei Yamada, Akira Sasaki, Atsunori Nakao

Acute medicine & surgery 8 ( 1 ) e651 2021

Language：English Publishing type：Research paper (scientific journal)

AIM: Although uncommon, medical emergencies arise in general dental practice. Inadequate data on their severity and frequency makes targeting medical education for general dental practitioners difficult. This also makes planning for unexpected events challenging for practitioners and makes collaborating with emergency physicians burdensome. We aimed to clarify the incidence and characteristics of a dental outpatient department's medical emergencies. METHODS: This single-center, retrospective, observational study was undertaken with patients who visited the dental outpatient department of Okayama University Hospital during the 8-year period. The primary outcome of the study was to identify the incidence and characteristics of medical emergencies in the dental outpatient department. Then we examined the timing of medical emergencies, administered medications, and final disposition (home/admission). RESULTS: During the period, 1,146,929 patients were enrolled. Forty-two patients (0.0037%) were consulted as medical emergencies. More than 60% of the incidents were vasovagal syncope, and dehydration and hypoglycemia were the second most prevalent at 9.5%. The most common types of dental treatments were tooth extraction (45.2%), followed by general dental treatment (28.6%), and other dental surgery such as implant placement (14.3%). Types of medical emergencies occurred equally before, during, and after dental treatment. Antihypertensive agents, sedatives, or glucose were used. For patients with emergencies, 90.5% recovered during the day and returned home, and 9.5% were hospitalized. CONCLUSION: The incidence of medical emergencies was low in our dental outpatient department. Knowledge of basic management principles, regular education for emergency care, and practicing first aid skills are mandatory for safe patient management.

DOI： 10.1002/ams2.651

Oral Ethanol Treatment for Ethylene Glycol Intoxication. Reviewed International journal

Misa Sasanami, Taihei Yamada, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

Cureus 12 ( 12 ) e12268 2020.12

Authorship：Corresponding author Language：English

Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.

DOI： 10.7759/cureus.12268

Delay in Emergency Medical Service Transportation Responsiveness during the COVID-19 Pandemic in a Minimally Affected Region. Reviewed

Kohei Ageta, Hiromichi Naito, Takashi Yorifuji, Takafumi Obara, Tsuyoshi Nojima, Taihei Yamada, Kohei Tsukahara, Hiromasa Yakushiji, Atsunori Nakao

Acta medica Okayama 74 ( 6 ) 513 - 520 2020.12

Language：English Publishing type：Research paper (scientific journal)

Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March-May 2019 or March-May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient's first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

DOI： 10.18926/AMO/61210

Burning Mouth Syndrome Induced by Angiotensin-Converting Enzyme Inhibitors. Reviewed International journal

Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Hitoshi Koga, Atsunori Nakao

Cureus 12 ( 11 ) e11376 2020.11

Authorship：Lead author Language：English

Burning mouth syndrome (BMS) is characterized as the sensation of burning in the tongue or any other area of the oral mucosa without a medical or dental cause. BMS's pathophysiology is poorly understood and may be caused by its association with various factors, particularly with antihypertensive or psychotropic medicines. Although BMS is a relatively common intraoral disorder in the dental field, emergency physicians rarely recognize it. We report a 53-year-old Japanese woman who presented to our ED with a three-week history of a strange taste and burning tongue. The patient had poor control of hypertension, captopril, an angiotensin-converting enzyme (ACE) inhibitor, was added three weeks before presentation. We discontinued her ACE inhibitor and changed her medication to a beta-blocker. After two weeks, her symptoms improved. Emergency physicians must be aware that ACE inhibitors play some roles in the pathogenesis of BMS. The correct diagnosis of the condition depends on recognizing the disease and improving the quality of life.

DOI： 10.7759/cureus.11376

インフルエンザウイルス感染を契機に上気道閉塞、意識障害を呈した甲状腺クリーゼ一例

佐々並三紗, 塚原紘平, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 山本浩継, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 1075 - 1075 2020.11

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report. Reviewed International journal

Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Respiratory medicine case reports 31 101182 - 101182 2020

Language：English

Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

DOI： 10.1016/j.rmcr.2020.101182

Transient Global Amnesia in a Patient Presenting with Hypertensive Emergency; a Case Report. Reviewed International journal

Takafumi Obara, Tsuyosi Nojima, Hitoshi Koga, Atsunori Nakao, Hiromichi Naito

Archives of academic emergency medicine 8 ( 1 ) e66 2020

Authorship：Lead author Language：English

Transient global amnesia (TGA) is characterized by the abrupt onset of global amnesia, particularly anterograde amnesia. The pathophysiology of TGA is poorly understood and it could be caused by various factors and be associated with various diseases. We report a 58-year-old man who presented to the local emergency room with TGA lasting for several hours. The patient had complete anterograde amnesia without a past medical history of migraine or neurological findings. His systolic blood pressure on presentation was 220 mmHg, which was immediately treated with intravenous calcium ion influx inhibitor. Other than global amnesia, there was no evidence of neurological disturbance. Computed tomography and magnetic resonance imaging results were unremarkable. After treatment of his hypertension, his amnesia resolved within 12 hours. Emergency department physicians may encounter TGA. Correct diagnosis of the condition depends on recognizing the disease.

A family intoxicated by daffodil bulbs mistaken for onions. Reviewed International journal

Kohei Ageta, Hiromasa Yakushiji, Yoshinori Kosaki, Takafumi Obara, Tsuyoshi Nojima, Akira Gochi, Hiromichi Naito, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e595 2020

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